Violence against workers in the hospital setting has become a growing public health concern in recent years, with 12-month prevalence estimates ranging from 23% to 74% in recent studies. These estimates are considered conservative given that several studies have observed significant underreporting of violent episodes experienced by hospital workers who often accept this as "part of the job." Violence perpetrated by patients and visitors has been reported to be the most common type of violence in this setting. There is a lack of standardized surveillance methodology to capture incident cases of workplace violence, as well as details about the circumstances surrounding these events in the hospital setting. Without these data, policy development is made informally or often based on sentinel events. We propose to design and implement a comprehensive surveillance system that serves to systematically capture episodes of workplace violence inflicted on hospital workers by patients and hospital visitors. This system will involve the design and implementation of enhanced reporting mechanisms through existing systems currently in place in these study hospitals, as well as the development and implementation of violence reporting policies and procedures. This study will take place in two large medical systems located in Texas and North Carolina. We will partner with key stakeholders in each study hospital to develop and implement both the reporting system and reporting policies, as well as promote and educate workers about the new mechanisms for reporting. We will assess the level of integration of the enhanced workplace violence surveillance system in each hospital. This research study addresses NIOSH's strategic goal for promoting effective occupational health surveillance conducted by employers. PUBLIC HEALTH RELEVANCE: This study will involve the development and evaluation of a workplace violence surveillance system in two large hospital systems, including six hospitals. We will use existing and newly collected data to examine the prevalence and incidence of violence initiated by patients visitors directed towards hospital workers. This study will also include a research to practice (R2P) component involving key stakeholders from these hospitals who will use these surveillance data to develop new, or refine existing, workplace violence reporting policies and procedures